Nursing Elites

1. A 14-year-old adolescent with a history of substance abuse is brought to the emergency department by the parents, who suspect that the adolescent has relapsed. What is the nurse’s priority action?

• A. Obtain a urine sample for toxicology screening
• B. Discuss treatment options with the parents
• C. Establish a therapeutic relationship with the adolescent
• D. Administer a medication to reverse the effects of the substance

Correct answer: A

Rationale: In this scenario, the nurse's priority action should be to obtain a urine sample for toxicology screening. This step is crucial in identifying the substances involved in the relapse, which will guide appropriate treatment strategies. By knowing the specific substances, healthcare providers can tailor treatment plans effectively. Establishing a therapeutic relationship and discussing treatment options come after obtaining necessary diagnostic information to ensure a comprehensive care plan. Administering a medication to reverse substance effects is not the initial priority; identification of the substances through toxicology screening should precede any treatment intervention.

2. When reinforcing information about the use of corticosteroids in treating asthma in children, which statement indicates that the parent understands the teaching?

• A. My child should take the medication only when experiencing symptoms.
• B. I will rinse my child's mouth after each use of the inhaler.
• C. I should discontinue the medication if my child seems better.
• D. Corticosteroids are used for quick relief during an asthma attack.

Correct answer: B

Rationale: Rinsing the mouth after using corticosteroid inhalers is crucial as it helps prevent oral thrush, a common side effect associated with these medications. This practice reduces the risk of developing fungal infections in the mouth and throat, maintaining optimal oral health during asthma treatment.

3. What age-appropriate play activity should the practical nurse suggest to the parents of a 7-month-old infant to encourage visual stimulation?

• A. Play peek-a-boo.
• B. Play pat-a-cake.
• C. Imitate animal sounds.
• D. Show how to clap hands.

Correct answer: A

Rationale: The practical nurse should suggest playing peek-a-boo to the parents of a 7-month-old infant to encourage visual stimulation. Peek-a-boo is a suitable game for this age group as it helps develop visual tracking skills and the concept of object permanence. By covering and uncovering their face or a toy, the infant learns that things still exist even when they cannot be seen, promoting cognitive development and visual engagement.

4. When assessing the breath sounds of an 18-month-old child who is crying, what action should the healthcare professional take?

• A. Document that the assessment is not available because the child is crying.
• B. Ask the caregiver to quiet the child so breath sounds can be auscultated.
• C. Allow the child to play with a stethoscope to distract them during auscultation.
• D. Auscultate and document breath sounds, noting that the child was crying at the time.

Correct answer: C

Rationale: Allowing the child to play with a stethoscope can help distract them, making it easier to auscultate breath sounds. This approach can create a more cooperative and engaging environment for the child, facilitating a more accurate assessment of their breath sounds. Choice A is incorrect because it does not address the need for an assessment. Choice B is not ideal as it puts pressure on the caregiver and may not be effective in calming the child. Choice D is not the best option as it does not actively involve the child in the assessment process and may not provide an accurate representation of their breath sounds.

5. The nurse is caring for a 3-year-old child who has been recently diagnosed with cystic fibrosis. Which discharge instruction by the nurse is most important to promote pulmonary function?

• A. Chest physiotherapy should be performed before meals and at bedtime
• B. Cough suppressants can be used up to four times a day for relief
• C. Oxygen should be given through a nasal cannula between 4-6 L/min
• D. Exercise is discouraged in order to preserve pulmonary vital capacity

Correct answer: B

Rationale: In cystic fibrosis, thick mucus obstructs the airways, making it difficult to clear from the lungs. Cough suppressants can help reduce the discomfort associated with persistent coughing, allowing the child to cough more effectively to clear the mucus, thus promoting pulmonary function. Chest physiotherapy, not exercise, helps mobilize the mucus. Oxygen therapy may be needed but is not the most important for promoting pulmonary function in this case.

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